"If I have teeth, I can smile." Experiences with tooth loss and the use of a removable dental prosthesis among people who are partially and ...
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
www.nature.com/bdjopen
ARTICLE OPEN
“If I have teeth, I can smile.” Experiences with tooth loss and the
use of a removable dental prosthesis among people who are
partially and completely edentulous in Karnataka, India
1✉
Anisha Rodrigues , Shradha Dhanania1 and Rashmi Rodrigues 2,3,4
© The Author(s) 2021
OBJECTIVES: Tooth loss is a phenomenon associated with structural and functional changes, with a negative influence on the oral
and general health of an individual. Removable dental prosthesis is commonly fabricated as treatment for tooth loss. However, the
perceptions and experiences of individuals during the transition from a dentate to a partially or completely edentulous state and
their acceptance of the denture are largely ignored. The objective of this study was to explore the perceptions and experiences
during the transition from a dentate state to being partially or completely edentulous in the Indian population.
METHODS: Fifteen individuals wearing partial or complete denture prosthesis were interviewed in depth using open-ended
questions. These interviews were recorded using a voice-recording device. They were then transcribed, and a coding process was
applied using the thematic framework approach to qualitative analysis.
FINDINGS: Five themes emerged, namely: (i) Transition from dentulous to partially or completely edentulous state; (ii) Varying
experiences with the use of dentures; (iii) Convenience and duration of wearing dentures; (iv) Attitude of dentists towards patients’
complaints; (v) Knowledge and preference of available treatment modalities.
CONCLUSIONS: The loss of natural teeth seemed to affect the psychological, functional, and social well-being of participants. Tooth
loss was believed to be a natural aging process. Costs of treatment deterred the uptake of fixed denture treatment options.
However, some participants preferred removable dentures to fixed prosthesis.
BDJ Open (2021)7:34 ; https://doi.org/10.1038/s41405-021-00088-z
INTRODUCTION distribution of the teeth missing, that might affect chewing ability
Edentulism (partial or total) is an irreversible oral health condition and esthetics [8]. Therefore, the perceptions of tooth loss may vary
and a public health concern due to its economic burden and its between individuals based on their personal, social and cultural
impact on quality of life. It is influenced by risk factors such as age, beliefs, life experiences, adaptive capability, age, gender and
sex, diet, oral hygiene, health behaviors, socioeconomic factors educational level [9]. The general belief among the elderly that
and level of education [1–3]. The most common causes of tooth tooth loss is concomitant with the physiologic process of aging
loss are periodontal disease and dental caries. The rates of tooth could influence their decision-making regarding preservation of
loss are higher in Low- and Middle-Income Countries when teeth or their extraction. Moreover, though tooth loss is
compared to High-Income countries that have benefitted from considered acceptable by some individuals, they could be
scientific advancements in oral health. unprepared for the physiological and structural changes that
The prevalence of edentulism in people above 50 years in India occur as a sequel, accompanied by negative emotions and a deep
was estimated to be 16.3% [4], while the caries experience in the sense of loss [10].
elderly was at 72%, with significant differences between the urban High-Income Countries have echoed a change in social norms
and rural population [5]. The prevalence of partial edentulism was that have lead to a change in attitudes of patients towards
45.5% and increased toward the lower end of the socioeconomic healthcare. Improved access to oral health care and health
spectrum [6]. information has enabled patients to engage in a more informed
Edentulism is a debilitating condition that manifests itself with decision making in relation to their treatment needs. A study
structural and functional changes leading to a deleterious impact among 45–75 year old Irish patients on their preference towards
on oral and general health, decreased masticatory efficiency, poor treatment options for their partially edentulous state revealed
facial appearance that adversely affects psychosocial well being high expectations and a high esthetic demand, preferring fixed
and oral health related quality of life (OHRQOL) [7]. The impact on replacements to removable dentures and conservation of natural
the OHRQOL however depends on the number, location and teeth [11]. However, studies in Nigeria [12] and Northern India [13]
1
Department of Prosthodontics, AJ Institute of Dental Sciences, Mangalore, India. 2Department of Community Health, St. John’s Medical College, St. John’s National Academy of
Health Sciences, Bangalore, India. 3Global Public Health, Karolinska Institutet, Stockholm, Sweden. 4DBT/Wellcome Trust India Alliance, Hyderabad, India.
✉email: anishasrod@gmail.com
Received: 26 June 2021 Revised: 11 August 2021 Accepted: 12 August 2021A. Rodrigues et al.
2
have shown that patients were more concerned with the languages i.e., Kannada, Tulu or Hindi. Each interview lasted 30–40 min.
debilitating effects of tooth loss on mastication than on esthetics. The recorded interviews were transcribed verbatim and translated to
There was higher acceptance of tooth loss and lower psychosocial English by an expert well versed in these languages as well as English. The
impact compared to their Western counterparts. transcribed data was then spot-checked by the authors to ensure
The different treatment modalities for tooth loss depending on the consistency with the recordings.
number and location of missing teeth include implant-supported
prostheses, fixed partial dentures (FPDs), removable partial dentures Data analysis
(RPDs) and complete dentures (CDs). While OHRQOL might not differ Transcribed data was analyzed using the thematic framework approach,
significantly between removable and complete denture wearers, it wherein a subjective interpretation of the data was done through a
systematic classification process of coding and identifying themes. The text
was reported that RPD wearers may face greater psychological and
was coded and the codes entered into a framework under which relevant
functional limitation than CD wearers who may have learnt to adapt data from the different transcripts was charted. Similar codes were brought
to their handicap during their transition from a partially to a under categories. Connections between the summaries were identified to
completely edentulous state [14]. form subthemes and overarching themes. This process was facilitated by
Though there is sufficient literature on OHRQOL related to tooth discussions between the authors.
loss and denture satisfaction, most of it is quantitative in nature
with little flexibility to holistically capture patients’ perceptions. In Ethics statement
this situation, qualitative research methods help explore, interpret An approval for the study was obtained from the Institutional Ethics
and obtain a deeper understanding of patient experiences, Committee. An informed consent was obtained from the participants prior
attitudes and expectations. They might also inform why certain to enrollment in the study. Verbal and written information regarding the
treatments or interventions work well with some patients, while aim, procedure and confidentiality of the study was given to all subjects.
with others they might not [15]. This understanding can aid an
integrative treatment approach for successful treatment outcomes Findings
of the edentulous. This is especially so as dentists are required to Overall, 15 partial and complete denture wearers participated in the study.
adopt a patient-centric approach towards treatment planning that They were aged 42–73 years, (mean age: 57.5years). Of these, seven were
ensures the knowledge, needs, experiences and expectations of men and eight were women. Eight participants were partial denture
1234567890();,:
patients’ are acknowledged. wearers and seven were complete denture wearers. Twelve participants
Further, given the transcultural differences in perceptions belonged to the lower socioeconomic group while three belonged to the
regarding tooth loss, translating findings from high-income middle socioeconomic group (Table 1).
contexts to India that has a diverse cultural background is not Five themes emerged from the analysis, namely: (i) Transition from
dentulous to partial or completely edentulous state; (ii) Varying
appropriate. It is therefore necessary, to understand the percep-
tions of the Indian population on tooth loss and the use of
dentures for appropriate patient-centric treatment and improved Table 1. Participants’ sociodemographic characteristics.
OHRQOL. Patient perceptions regarding tooth loss and rehabilita-
tion have implications not only for dentists but also for policy Characteristic Participants (n = 15)
makers to bring about necessary changes in oral health policies Age 57.5 (±9.7)
regarding patient education, access and affordability of dental Gender
treatment [11, 16]. We therefore undertook this study to assess the
perceptions surrounding tooth loss and life with a dental Male 7 46.7%
prosthesis. Female 8 53.3%
Education
Primary 4 26.7%
METHODS
The study was conducted in the Department of Prosthodontics, A.J. High school 9 60%
Institute of Dental Sciences, Mangalore, Karnataka, South India. A.J. Graduate 2 13.3%
Institute of Dental Sciences is a tertiary care center and a dental teaching
Occupation
institute, located in an urban area. Dental treatment at the institute is
provided at no-cost or at a nominal cost to all patients, depending on the Unemployed 4 26.7%
type of treatment required. The Institute is also associated with the “Danta Unskilled 4 26.7%
Bhagya Yojana” which is an oral health initiative by the Karnataka State
government. The initiative provides free complete dentures to patients Semiskilled 5 33.3%
aged > / = 45 years and belonging to low-income groups. The institute Clerical/farm 2 13.3%
therefore has a huge influx of patients, particularly from the low-and- Socioeconomic status
middle income, not only from the city and surrounding areas, but also from
the neighboring districts, despite the existence of large number of private Lower/upper lower 12 80%
dental clinics in the region. Lower middle 3 20%
This qualitative study involved in-depth interviews with 15 participants
who either had partial or complete denture prosthesis. Purposive sampling Dental status
ensured that male and female patients aged above forty years using a Partially edentulous 8 53.3%
removable partial or complete denture with not more than twenty-four Completely edentulous 7 46.7%
remaining natural teeth were included. The interviews were audio
recorded using a voice-recording device and were conducted in a pleasant Period Of denture wear
quiet room by SD and AR. They had no role in providing dental care to the 20 years 1 6.6%
Spontaneous and planned probes were used to obtain a deeper insight Socioeconomic status based on Kuppuswamy’s socio-economic status
into the responses. The interviews were conducted in English or the local scale 2019.
BDJ Open (2021)7:34A. Rodrigues et al.
3
experiences with the use of dentures; (iii) Convenience and duration of
wearing dentures; (iv) Attitude of dentists towards patients’ complaints; (v) “I go to some supply work, where everyone sees me. If I don’t have
Knowledge and preference of available treatment modalities (Table 2). teeth, they might feel that I am not good looking. See, there is this
actor Raj Kumar. He is 75 years old but he looks and acts like he is 55
because he has teeth.” (Male, Completely edentulous participant).
Theme 1: Transition from dentulous to partial or completely
edentulous state Tooth loss affected speech and phonetics due to involuntary movement
Most participants had experienced tooth loss during their adolescence and of the tongue into the edentulous space. A religious woman felt that
early adulthood (20–35 years). While they initially lost one or two teeth, the missing teeth affected her recitation of the Holy Book. The problem was
number increased as they grew older. Tooth loss was attributed to lack of resolved after wearing a denture.
information on oral health care and preventive measures, and difficulty in Tooth loss affected diet and eating habits. Some could “never eat hard
availing dental services mainly due to poor accessibility and financial items”, could not eat quickly and therefore changed their food habits by
constraints. Teeth weren’t deemed important and participants resorted to having soft, over boiled or mashed food. Though they felt that tooth loss
home remedies for tooth pain, seeking professional care only when the didn’t affect general health, some participants expressed their concern
situation worsened. They preferred to get their teeth extracted, as they about indigestion due to inefficient chewing of food.
believed that dentures were the best solution that would eliminate tooth
related problems, were more economical and would require fewer future
dental visits. Need for tooth replacement
The participants expressed the need for better esthetics, improved
chewing and speech and therefore sought tooth replacement. One
Perceptions of the tooth loss phenomenon participant said he wanted to “reduce his age” and avoid being called
The participants had varied perceptions and experiences with tooth loss. “grandfather”. Some partially edentulous participants had to be coerced
Some perceived tooth loss as an unavoidable age related natural into getting dentures by their spouse, friends, children and even the
phenomenon, and therefore wasn’t a serious issue. They also believed dentist. Yet, they delayed treatment till they faced major issues or lost
that as individual characteristics vary, so does tooth loss, depending on the more teeth. Some participants chose to get their remaining teeth extracted
individual’s systemic and risk factors. and preferred complete dentures over partial dentures. One participant
explained:
“It (tooth loss) is natural. At around 50–80 years of age, only 50% of
natural teeth remain. The rest, even if good, are 100% guaranteed to “Only one, two, three teeth were missing. I had no idea about the
fall. It cannot be stopped by anyone.” (Male, Complete denture replacement… and treatment was not that advanced… there was no
participant). one to suggest me treatment options.” (Male, Partially edentulous
participant).
The participants acknowledged that lack of oral health knowledge, busy
work schedules and time constraints, were reasons why they suffered
dental decay, periodontal disease and eventual tooth loss. Some
participants stated that their teeth were lost without the dentist’s Theme 2: Varying experiences with the use of dentures
Irrespective of the type of denture (partial or complete), participants
intervention, mainly due to tooth mobility and “loose gums”. Oral hygiene
seemed to share similar experiences.
was deemed important, and the lack of it affected social life.
Initial phase of adaptation to dentures
“It is correct that teeth go away with age… but it is not natural to lose Participants reported negative experiences during the phase of initial
teeth in our age. We do not know how to clean properly. In front of the adaptation to dentures, especially with mastication, denture retention,
public we should look good. So, oral health is very important and we ulcerations, taste impairment, and increased salivation. However, over
should maintain it. Bad oral hygiene will cause bad breath and also time, some issues were resolved.
change the tooth color to yellow. We feel hesitant to talk to people.”
(Female, Partially edentulous participant).
“Initially, I didn’t feel any taste. Now, I am used to it. When I got the
denture, it used to slip but now it’s fine.” (Male, Completely edentulous
participant).
Psychosocial impact of tooth loss
Though tooth loss was considered a normal occurrence, some participants
Many participants experienced difficulty in chewing and taking longer to
expressed a sense of loss, as they felt that dentures were no match to eat with dentures. They complained of food lodgment beneath dentures
natural teeth. The shape of the face seemed altered, speech was affected and some partial denture wearers preferred to eat without dentures. Some
and difficulty with chewing, led them to avoid social gatherings. They felt that dentures had a “plastic feel” to them and were thick. One
eventually felt that natural teeth were “God’s gift.” Almost all participants participant who could not adapt to his dentures and stopped wearing
expressed feelings of embarrassment and being self-conscious.
them said:
“I felt bad when they (friends) could talk and I couldn’t talk like them. It
did not look good… Everybody, all friends made fun.” (Male, Partially “I couldn’t bite. I couldn’t eat anything hard. Upper set used to fall
edentulous participant). down and lower set used to fly up. When I spoke loudly, the teeth
would touch. So, now I think I’ll get a fixed one otherwise it will be the
However, missing teeth did not lead to embarrassment before their same again.” (Male, Completely edentulous participant).
spouses, and such issues were considered a “wrong thinking process”.
Dentures helped restore the self-confidence of some participants, as
they looked natural and improved their facial appearance. One participant
explained: Benefits of wearing dentures
Dentures improved the appearance, speech and self-esteem of the
participants, as they looked lifelike, were similar or even better than
“Now don’t I look good with the denture? Or else who would look at natural teeth and greatly helped with chewing.
my face? When I used to go to a function, I used to take my plate
separately. I used to hide behind the pillar and eat, so that people don’t “Denture gives strength to cheek… the pain also reduced…no
see me eating.” (Male, Completely edentulous participant). problem to bite. It looks good…yellow color or gaps don’t look
good… it (denture) also increases my confidence and makes me a look
Teeth were considered important to function well at work: good.” (Female, Partially edentulous participant).
BDJ Open (2021)7:344
Table 2. Themes and quotes.
Thematic framework components and quotes Codes Categories Subthemes Themes
Importance of oral health
I feel it (tooth loss) is a normal process. What I feel is that it is due to Perceived notion that teeth will fall Age-related natural process Perceptions of the tooth loss 1
age also, and maybe, I’m not cleaning properly. off with age phenomenon
Problems without teeth
I couldn’t smile properly during the healing period for around Self conscious about appearance and Embarrassment in public Psychosocial impact of 1
20 days. I didn’t attend functions for sometime since it was my front speech edentulism
teeth. When I lost my lower teeth, it didn’t affect much… I used to Did not socialize
be careful while talking.
Denture experiences
With the upper denture, I used to have pain. The skin used to peel Painful ulceration Denture problems Initial adaptation to dentures 2
off when I wore it. I used to find it difficult initially but later got Adapted over time
used to it.
I can eat anything that you say. Even hard food. After going back Able to eat hard food Pleased with dentures Benefits of wearing dentures
home, I can video call and show you, or even make a video and Can prove it to anyone
upload it on YouTube.
I feel natural teeth are better. I feel the difference. Natural is always Regret having to wear dentures Unhappy with dentures Disadvantages of dentures
natural and it’s God gift…Food gets stuck in the denture but not in
natural teeth.
Denture usage
I don’t feel it necessary to wear the denture at home. I mainly wear Denture not worn at home Denture use Denture wearing habits 3
A. Rodrigues et al.
it to cover the hole when I smile.
Dentists’ attitude
I put denture in the mouth my words were not coming out Not happy with the dentist’s attitude Indifference of dentists towards Patient dentist relationship 4
properly. I told him that I do not like his work..so he replied that and work patient complaints
“this is how it will be.. whatever measurement you have given, it is
according to that”. I did not wear the denture. I just used it for one
or two days…I threw it... he made me a fool.
Treatment options
I feel the removing one is better. I feel it is easy to clean and I feel Better maintenance of removable Removable dentures better Perceptions about removable 5
fixed dentures are very dangerous. dentures than fixed dentures
I didn’t want fixed because I feel that I will have some problem Afraid of fixed dentures Problems with fixed dentures Deterrents for fixed denture
because of it. I feel it will painful. Fixed dentures cause pain treatment
Themes: 1. Transition from dentulous to partial or completely edentulous state; 2. Varying experiences with the use of dentures; 3. Convenience and duration of wearing dentures; 4. Attitude of dentists towards
patients complaints; 5. Knowledge and preference of available treatment modalities.
BDJ Open (2021)7:34A. Rodrigues et al.
5
One of the participants explained how the denture enabled him to
socialize with people: “I can take out these dentures and clean them. Even gums can be kept
clean.” (Female, Partially edentulous patient).
“It is very good. I can go out. I can talk to people. I can sit in front of
people. I can look at myself. I feel very happy. When I didn’t have teeth,
people used to keep staring at my mouth.” (Male, Completely Deterrents for fixed denture treatment options
edentulous participant). Increased cost of fixed dentures and implants were the main reasons to
opt for removable dentures. Fear of pain involved was commonly cited by
the participants.
Theme 3: Convenience and duration of wearing dentures “They said they will give me fixed teeth. But, I said I don’t want fixed
The partial denture participants chose to wear dentures to suit their because I was scared. If it starts hurting again, they will remove
comfort and necessity, mainly esthetics. everything with pliers. So, I told them I don’t want fixed, I want
removable.” (Male, Completely edentulous participant).
Denture wearing habits
A few of the partial denture participants preferred to eat without
dentures, as it took longer to eat with them, especially while in a hurry.
Those who were comfortable without dentures did not wear them DISCUSSION
indoors. One of the respondents felt “weird” wearing dentures and wore The findings of our study revealed the perceived need for tooth
them only when going out. On the contrary, some participants did not replacement for better esthetics and function. It also revealed the
remove the dentures while traveling to other places, and wore them
even while sleeping in the night. A participant who felt no one should vulnerability of the participants to edentulism that resulted from
know of his denture said: negligence of oral health care due to a belief of inevitable tooth
loss in the aging process. The participants in our study belonged
to the lower socioeconomic group with a low educational level.
“When I traveled to some other village, I did not take out the dentures Socioeconomic inequities are known to negatively influence oral
at all. No one got to know. When I am at home, I take out the denture health as people belonging to this group are more susceptible to
for 3–4 h a day as it wouldn’t be an embarrassment.” (Male, Completely dental caries, periodontal disease and subsequent tooth loss [9].
edentulous participant).
People within this group exhibit low oral health literacy, poor
access to oral health and financial barriers to oral health care. In
addition, the clinical management decisions by dentists might be
Spare dentures different for this group due to treatment unaffordability. Dentists
Some participants preferred to have two sets of dentures, fearing could possibly harbor negative perceptions of this group being
accidental loss or breakage of the denture. One considered it a luxury to ignorant and disregarding of their regular dental appointments
have two dentures, which he thought could be worn alternatively.
and preventive practices.
Changes in appearance and difficulties with speech and
“It will be good if I have two sets, sometimes I can use this, sometimes
chewing had a negative psychosocial impact on our participants.
that. Like if we have two cars, we can use both. Same way.” (Male,
Completely edentulous participant).
The emotions were complex, as they experienced embarrassment
and low self-confidence, sadness and even resignation to mock-
ery. It has been suggested that patients would be better prepared
for the psychological effects of tooth loss if they had received
Theme 4: Attitude of dentists towards patients’ complaints advice from their dentists prior to teeth extraction. The
While most participants seemed very happy and satisfied with their dentist participants expressed embarrassment of being seen without
and the treatment they received, some were put off by the impatience and
an indifferent attitude shown by the dentists due to which they were teeth in public. However, they did not feel embarrassed in front of
reluctant to disclose their problems. They chose to wear their ill fitting their spouses as it was considered a natural aging process. Similar
dentures fearing the dentist would ask them to get new dentures rather findings were noted in studies on elderly edentulous subjects in
than fix their existing ones. One participant, unhappy with his denture Iran and Hong Kong where strong cultural beliefs exist [17, 18]. In
seemed very upset with his dentist: contrast, a study on edentulous patients in London stated that a
majority of the patients avoided letting their partners see them
“The setting (denture) he gave was of plastic. I put it inside the without dentures [10].
mouth… words weren’t coming out properly. I told him that I did not Social and cultural factors have a very strong influence on the
like his work. He replied: ‘this is how it will be… whatever healthcare beliefs and practices in the Indian population. The
measurement you have given, it is according to that’. I did not wear general belief was that loss of teeth is a natural process, inevitable
it. I just used it for one or two days…I threw it… he made me a fool.” and unavoidable. This belief stems from a socio-cultural attribute
(Male, Completely edentulous participant).
linking the aging process with a decline in health [19]. Another
common belief is that dentures are better than natural teeth as
they require low maintenance, ensure permanent elimination of
Theme 5: Knowledge and preference of available treatment pain and other dental problems, and would minimize future
modalities dental visits, thereby reducing costs of care. Several studies have
There wasn’t much awareness about the treatment options among the reported similar findings reflecting the participants’ feelings of
participants, who mainly relied on the dentist to make decisions for them. resignation and acceptance of imminent tooth loss [9, 10, 18, 20].
Most participants were not aware of dental implants as treatment options. Almost all our participants expressed difficulty in mastication
due to tooth loss. The increased number of missing teeth led to a
Perceptions about removable dentures change in their dietary habits and food choices leading to
Though most participants were satisfied with their existing dentures, there consumption of soft food and sugary drinks, which in turn led to
were complaints of painful gums, food lodgment and unstable mandibular the problems of indigestion. Similarly, the study from Iran,
complete dentures. However, some preferred removable dentures to fixed
reported that their participants believed improper chewing of
dentures, as they were affordable, easy to clean and maintain. They
seemed more practical as they could be removed and cleaned whenever
food led to stomachache, distention and even nocturnal
required. dyspnoea. Though they had initially adapted to tooth loss, they
BDJ Open (2021)7:34A. Rodrigues et al.
6
eventually faced a crisis [17]. Dental status appeared to influence lower socioeconomic levels who expressed similar perceptions
food selection and nutritional intake leading to a poor nutritional and experiences with tooth loss and rehabilitation. There is a need
status in older adults in UK [21]. for measures to improve oral health awareness, reduce oral health
Most participants in our study expressed great satisfaction with inequalities, promote affordable dental health care and effective
their dentures. Though they faced initial difficulties with their dentist–patient relationships particularly in the low-and middle-
dentures, benefits outweighed problems. Only one of our income countries.
participants was unhappy with his denture due to its poor
retention and looked for fixed alternatives. A qualitative study in Strengths and limitations
Brazil shares similar experiences of adaptation and acceptance of The qualitative study design provided us greater flexibility in
new dentures. The patients were greatly satisfied with treatment exploring and understanding the complex issues and situations
outcomes that provided functional and esthetic benefits [22]. related to tooth loss and the use of removable dentures. Unlike a
Patient satisfaction with dentures may not correlate to the quantitative assessment, the qualitative design facilitated an in-depth
dentists’ evaluation of the prosthesis as patients are known to understanding of participant perceptions and experiences. Authors
adapt to inadequate dentures, suggesting the influence of AR and SD, being prosthodontists as well as researchers, were able to
psychosocial and demographic variables with denture satisfaction. effectively contextualize the responses and provide holistic inter-
Less educated patients have exhibited greater denture satisfaction pretations of the findings. Both authors discussed the details of the
that is attributed to their lower levels of expectation. Also, higher interviews and the results at different stages of the analysis, resolving
economic status has been negatively correlated with denture any conflict. Further assistance was obtained from author RR, who is
satisfaction [23]. experienced in mixed methods research. Thus, the credibility of the
The patients’ preference for treatment options are known to findings was ensured. However, the findings being driven by
largely depend on their knowledge regarding various treatment personal experiences, individual beliefs, socioeconomic and cultural
modalities and their financial concerns [24]. A higher literacy and backgrounds of the participants and the experiences of the
educational level is associated with patient preference for fixed researchers may not be reflective of a wider population. A description
dentures [25, 26]. Though our Dental Institute offers treatment at of our study context has therefore been provided in the methods
no-cost to patients requiring RPD, CD and FPD, most of our section of this manuscript that would enable the reader judge the
participants preferred removable dentures due to their ease of applicability of the findings to a different setting.
maintenance, and the fear of pain with fixed dentures. Those who
preferred implant supported prostheses, expressed costs as a
major deterrent. A study on the knowledge and attitude towards CONCLUSION
prosthetic rehabilitation in Central India showed that a majority of This study provides an insight into the perceptions and
patients had insufficient knowledge about the various treatment experiences of people wearing removable dentures during the
options. This knowledge was influenced by demographic factors transition from a dentulous to an edentulous state, and finally to a
like income, education, gender and age [27]. dental prosthesis. Though tooth loss was considered a normal
Though most patients expressed satisfaction with their dentist, aging process, it affected their psychological, functional, and social
not all patients felt the same. The attitude of the dentists towards well-being. Participants were greatly satisfied with their dentures
denture patients could be considered as one of the gray areas that despite the initial issues with its adaptation. It is essential for
are seldom highlighted in edentulous patient care. In our study, individuals to recognize the concept of maintenance of oral health
the participants trusted their dentists in decision-making. Dentists at an early age and the need for appropriate dental rehabilitation
should therefore build a good rapport and a trusting relationship when necessary to improve their oral health related quality of life.
with patients and understand their mental status before
commencing treatment procedures [28]. It is also important to
develop patience and soft skills for effective patient communica- REFERENCES
tion especially with denture wearers during their transition phase
1. Kailembo A, Preet R, Stewart Williams J. Common risk factors and edentulism in
so that patients can better deal with the denture related problems. adults, aged 50 years and over, in China, Ghana, India and South Africa: results
In addition, dentists should ensure continuity of care for their from the WHO Study on global AGEing and adult health (SAGE). BMC Oral Health.
patients, paying heed to their sociocultural, psychological and 2016;17:29.
economic situation. Relational continuity can be achieved through 2. Tsai S-J, Lin M-S, Chiu W-N, Jane S-W, Tu L-T, Chen M-Y. Factors associated with
better communication and continued engagement. Being avail- having less than 20 natural teeth in rural adults: a cross-sectional study. BMC Oral
able for dental consultations whenever required ensures cons- Health. 2015;15:158.
tinued care to the patients. This can reduce treatment costs, 3. D’Souza KM, Aras M. Association between socio-demographic variables and
promote dental health, improve compliance to treatment as well partial edentulism in the Goan population: an epidemiological study in India.
Indian. J Dent Res. 2014;25:434.
as patient satisfaction thereby improving treatment outcomes
4. Peltzer K, Hewlett S, Yawson AE, Moynihan P, Preet R, Wu F, et al. Prevalence of
[29]. Also, dentists can complement the public health care systems loss of all teeth (edentulism) and associated factors in older adults in China,
by creating oral health awareness, stressing on favorable oral Ghana, India, Mexico, Russia and South Africa. Int J Environ Res Public Health.
health behaviors, the importance of oral rehabilitation and the 2014;11:11308–24.
treatment options for the same. 5. Shah N, Karimassery S. Impact of socio-demographic variables, oral hygiene
The participants in our study included both partial and practices, oral habits and diet on dental caries experience of Indian elderly: a
complete denture wearers and explored how differently they community-based study. Gerodontology. 2004;21:43–50.
perceived their edentulous and denture experiences. By large, 6. George B, John J, Saravanan S, Arumugham IM. Prevalence of permanent tooth
they seemed to share similar experiences especially with their loss among children and adults in a suburban area of Chennai. Indian. J Dent Res.
2011;22:364.
dentures. All participants experienced initial problems with
7. Emami E, de Souza RF, Kabawat M, Feine JS. The impact of edentulism on oral and
adaptation to dentures. However, issues related to mastication general health. Int J Dent. 2013;2013:498305. https://doi.org/10.1155/2013/498305.
and retention of dentures were more prevalent in complete 8. Gerritsen A, Allen P, Witter D, Bronkhorst E, Creugers N. Tooth loss and oral
denture patients. Eventually, most of them got accustomed to and health-related quality of life: a systematic review and meta-analysis. Health Qual
were quite pleased with their dentures. RPD wearers chose to Life Outcomes. 2010;8:126.
wear their dentures to suit their requirement and convenience. 9. De Marchi RJ, Leal AF, Padilha DM, Brondani MA. Vulnerability and the psycho-
The findings of our study are consistent with the findings of social aspects of tooth loss in old age: a Southern Brazilian Study. J Cross Cult
similar studies in other countries on participants belonging to the Gerontol. 2012;27:239–58.
BDJ Open (2021)7:34A. Rodrigues et al.
7
10. Davis D, Fiske J, Scott B, Radford D. The emotional effects of tooth loss: a pre- 29. Shrivastava R, Couturier Y, Simard-Lebel S, Girard F, Aguirre NVB, Torrie J, et al.
liminary quantitative study. Br Dent J. 2000;188:503–6. Relational continuity of oral health care in Indigenous communities: a qualitative
11. Cronin M, Meaney S, Jepson N, Allen P. A qualitative study of trends in patient study. BMC Oral Health. 2019;19:287.
preferences for the management of the partially dentate state. Gerodontology.
2009;26:137–42.
12. Azodo C, Soroye M. Partial edentulism and unmet prosthetic needs amongst young ACKNOWLEDGEMENTS
adult Nigeria. Odonto-stomatologie Tropicale = Tropical Dent. J. 2014;37:47–52. Shradha Dhanania and Anisha Rodrigues share co-first authorship.
13. Naik AV, Pai RC. Study of emotional effects of tooth loss in an aging North Indian
Community. ISRN Dent. 2011;2011:e395498.
14. Bae KH, Kim C, Paik DI, Kim JB. A comparison of oral health related quality of life
between complete and partial removable denture-wearing older adults in Korea. AUTHOR CONTRIBUTIONS
J Oral Rehabil. 2006;33:317–22. AR was involved in concept design, data collection, data analysis and drafting the
15. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual paper. SD was involved in concept design, data collection and drafting the paper. RR
Health Res. 2005;15:1277–88. was involved in data analysis and critical review of the paper.
16. Singh S, Shah V, Dagrus K, Manjunatha BS, Kariya P, Shah S. Oral health inequality
and barriers to oral health care in India. Eur J Dent Ther Res. 2015;4:242–5.
17. Dezhdar S, Fereidoonpoor N, Mostaghni E, Jahanpour F, Ravanipour M. Transition COMPETING INTERESTS
from being OK to NOT OK with tooth loss among a selection of older people in The authors declare no competing interests.
Iran: a qualitative study. Gerodontology. 2017;34:215–26.
18. McMillan A, Wong M. Emotional effects of tooth loss in community dwelling ETHICS APPROVAL
elderly in Hong Kong. Int J Prosthodontics. 2004;17:172–6. An approval for the study was obtained from the Institutional Ethics Committee, AJ
19. Dable RA, Yashwante BJ, Marathe SS, Gaikwad BS, Patil PB, Momin AA. Tooth loss Institute of Medical Sciences and Research Centre (AJEC/REV/199/2017).
– how emotional it is for the elderly in India? Oral Health Dent Manag. 2014;13:6.
20. Omar R, Tashkandi E, Abduljabbar T, Abdullah MA, Akeel RF. Sentiments
expressed in relation to tooth loss: a qualitative study among edentulous Saudis. ADDITIONAL INFORMATION
Int J Prosthodont. 2003;16:515–20. Correspondence and requests for materials should be addressed to A.R.
21. Watson S, McGowan L, McCrum L-A, Cardwell CR, McGuinness B, Moore C, et al.
The impact of dental status on perceived ability to eat certain foods and nutrient Reprints and permission information is available at http://www.nature.com/
intakes in older adults: cross-sectional analysis of the UK National Diet and reprints
Nutrition Survey 2008–2014. Int J Behav Nutr Phys Act. 2019;16:43.
22. Silva JDCM, Dos Santos JFF, Marchini L. Factors influencing patients’ satisfaction Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims
with complete dentures: a qualitative study. BDS. 2014;17:83. in published maps and institutional affiliations.
23. Čelebić A, Knezović-Zlatarić D, Papić M, Carek V, Baučić I, Stipetić J. Factors
related to patient satisfaction with complete denture therapy. J Gerontology Ser
A. 2003;58:M948–53.
24. Lima de Paula LML, Sampaio AA, Costa JG, Gomes VE, Ferreira EFE, Ferreira RC. The Open Access This article is licensed under a Creative Commons
course from tooth loss to successful rehabilitation with denture: feelings influenced Attribution 4.0 International License, which permits use, sharing,
by socioeconomic status. SAGE Open. Medicine. 2019;7:2050312119874232. adaptation, distribution and reproduction in any medium or format, as long as you give
25. Al-Quran FA, Al-Ghalayini RF, Al-Zu’bi BN. Single-tooth replacement: factors appropriate credit to the original author(s) and the source, provide a link to the Creative
affecting different prosthetic treatment modalities. BMC Oral. Health. 2011;11:34 Commons license, and indicate if changes were made. The images or other third party
26. Jayasinghe RM, Perera J, Jayasinghe V, Thilakumara IP, Rasnayaka S, Shiraz MHM, material in this article are included in the article’s Creative Commons license, unless
et al. Awareness, attitudes, need and demand on replacement of missing teeth indicated otherwise in a credit line to the material. If material is not included in the
among a group of partially dentate patients attending a University Dental Hos- article’s Creative Commons license and your intended use is not permitted by statutory
pital. BMC Res Notes. 2017;10:334. regulation or exceeds the permitted use, you will need to obtain permission directly
27. Gupta S, et al. Knowledge and Attitude towards Prosthodontic Rehabilitation and from the copyright holder. To view a copy of this license, visit http://creativecommons.
Utilization of Dental Services by Central India Population of Jabalpur City, India. org/licenses/by/4.0/.
Ann Med Health Sci Res. 2018;8:12–5.
28. Roessler DM. Complete denture success for patients and dentists. Int Dent J.
2003;53:340–5. © The Author(s) 2021
BDJ Open (2021)7:34You can also read
